Wednesday, October 28, 2015

Can literature inoculate against burnout?

This cat had an ingrown toenail. I didn't exactly become a vet to trim nails, but I did seek to help animals and removing this one relieved a huge amount of discomfort.
Do health professionals shed their ideals as their careers progress? What were your aspirations when you became a veterinarian, vet nurse, tech or whatever it is you became? Do you hold these same aspirations now?

In a thought-provoking article, doctor and writer Richard Gunderman argues that – at least in medical students – burnout occurs due to abandonment of these core aspirations.
Burnout at its deepest level is not the result of some train wreck of examinations, long call shifts, or poor clinical evaluations. It is the sum total of hundreds and thousands of tiny betrayals of purpose, each one so minute it hardly attracts notice.
They may begin medical school with a desire to help others, but Gunderman argues that many find financial concerns – like their own massive (and getting bigger) student debt – dominating their career plans. He cites the example of Dr Tertius Lydgate from George Eliot’s Middlemarch.

Studies repeatedly document a decline in empathy of vet and medical students. Why and how is this so? My theory is that senior students fixate on the technical aspects – performing the best surgery, perfecting catheterisation, mastering diagnostic algorithms – perhaps (if briefly) losing the holistic perspective.

But Gunderman argues it is the work of a hidden curriculum.
What alterations are we asking them, explicitly or implicitly, to make in the ways they act, think and feel? In what ways are we bringing out the best elements in their character – courage, compassion and wisdom – as opposed to merely exacerbating their worst impulses- envy, fear and destructive competitiveness?
He argues that we should be feeding the imagination of students, and nourishing their humanity, by provide resources for reflection about those core aspirations and ideals. Gunderman doesn't go as far as arguing that literature can protect against burnout, but he does suggest that nourishing the imagination of doctors (and I assume other health professionals) is good for the soul.

This year the medical journal The Lancet has introduced a column, From Literature to Medicine, drawing lessons, observations and reflections from medical fiction. Literature can confront us with questions that textbooks won’t raise. 

For example, in their discussion on Tea Obreht’s The Tiger’s Wife, Daniel Marchalik and Ann Jurecic comment that stories enable us to “navigate the liminal space between reason and emotion”. The book imparts observations that a textbook would not, such as “the knowledge of a patient’s impending death and the inability to prevent it is the requisite struggle of physicians.” Indeed, no medical or surgical textbook confronts this type of moral stress.

Is there scope for a column like this in a veterinary journal? Would we serve students better by setting up a veterinary book club? Are there any fiction books that have spoken to you, provided insight or comfort or raised questions you couldn’t quite crystallise?


Gunderman R (2014) For the young doctor about to burn out. The Atlantic

Marchalik D & Jurecic A (2015) Stories for survival. The Lancet. 386:1230.